Healthcare Provider Details

I. General information

NPI: 1902082118
Provider Name (Legal Business Name): MR. VAUGHN FRYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 COOPER ST. COSTAR CENTER
CAMDEN NJ
08102
US

IV. Provider business mailing address

900 DUDLEY AVE. SJHBR
CHERRY HILL NJ
08002
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-1700
  • Fax: 856-225-1373
Mailing address:
  • Phone: 856-541-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: